Postpartum Focused Flashcards
what does BUBBLES stand for?
B-breast U-uterus B-bladder B-bowel function L-lochia E-episiotomy, perineum, incision S-status of emotions
what is important during the breast assessment?
- palpate: are the breasts full, firm, tender or shiny?
- is the skin warm?
- are there distended veins?
- any pain reported?
- what do the nipples look like
- is the patient wearing appropriate nursing bra?
- is her baby able or unable to feed at the breast?
what is important to teach the patient regarding the breast?
- process of milk production
- answer any breastfeeding questions
- discuss supportive bra and/or binder
what is important during the uterus assessment?
- *perform uterus assessment after having the patient empty their bladder
- palpate: is the uterus firm or boggy; what is the size of the uterus
- any bleeding? how much
- any pain?
what is important to teach the patient regarding the uterus?
-explain involution and what is considered successful/unsuccessful
what is important during the bladder assessment?
- inspect & palpate while checking fundal height; is the bladder full or empty?
- any bladder pain; before and or during urination?
- and bleeding with urination?
what is important to teach during the bladder assessment?
- talk with the mother about good perineal care!
- educate on the peri-bottle
- educate on wiping from front to back
- *encourage pelvic rest
- encourage handwashing
what is important during the bowel function assessment?
- has the patient had a bowel movement? when? how much? was it regular?
- any bowel pain?
- constipation?
what is important to teach during the bowel function assessment?
- educate on the importance of fluids, fiber and ambulation!
- *encourage the use of stool softeners, as ordered, to promote proper bowel function
what is important during the lochia assessment?
how would you describe it?:
-rubra (red in color), normal during days 1-3 PP
-serosa (pink in color), normal during days 3-10 PP
-alba (creamy yellow), normal during 1-2 weeks PP
how much is there?
-scant bleeding = less than 1 inch in 1 hour
-light bleeding = less than 4 inches in 1 hour
-moderate bleeding = less than 6 inches in 1 hour
-heavy bleeding = saturated in 1 hour
are there any clots? **should never be larger than a lime in size; change sized clots are to be expected BUT if there are a lot of them, this indicated HEAVY bleeding, regardless of size.
what is important to teach during the lochia assessment?
- educate the patient on the importance of monitoring the amount of bleeding and color of bleeding, also report any clots.
- inform the patient about the changes she will go through
what is important during the episiotomy, perineum and incision assessment?
- inspect: check the rectal area
- is there an incision? what degree?
- how does the skin around the incision/episiotomy look?
- any redness, warmth?
- patient experiencing any pain?
- inspect the C-Section area, warm/red?
what is important to teach during the episiotomy, perineum, and incision assessment?
- answer any questions the patient has regarding the pain, cleaning the area, sex in the future
- encourage the use of an abdominal binder if the patient had a C-Section
what is important during the status of emotions assessment?
- *evaluate the patients emotional status while assessing the rest of the BUBBLES areas
- is the patient happy or sad?
- is the patient doing things for herself or needing help with everything?/ independent or dependent?
- what does she say about the new baby/family
- does she interact with the new baby? does she take care of the new baby?
- **be respectful of different cultures and know what is expected/normal for those cultures!
what is important to teach during the status of emotions assessment?
-explain + educate the patient on the normalcy of crying easily, and easily changing emotions.
-explain the difference between PPD & the baby blues
^^^the baby blues are ok during the first few weeks PP
what is known as the postpartum period?
beginning immediately after delivery, until about 6 weeks after the birth; includes the healing of the reproductive tract
Urinary changes in the postpartum mother
- kidneys + ureters return to normal in about 4-6 weeks
- bladder returns to normal in about 1 week
- *if there is any type of trauma to the perineal area, there might be affected function for a while PP
- monitor for UTI, UTIs are common PP
GI changes in the postpartum mother
- *hunger returns, full force right after birth, most mothers do not eat during the entire labor/delivery, and sometimes right after delivery; these mothers will be super hungry after birth
- the digestive tract is still slow after labor & delivery, esp. if the patient received an epidural and/or local anesthetic
- has there been any GI trauma?
Perfusion changes in the postpartum mother
-blood volume increases up to 50% during pregnancy
**returns to pre-pregnancy volume at about 2 weeks postpartum
^^how does the volume return to normal? through sweating!
-immediately after birth, the HR lowers but the BP raises; does return to normal within a dew days.
-orthostatic hypotension is normal PP
**cardiac function may not return to baseline until up to 6 MONTHS postpartum
-estrogen during pregnancy increases risks for clotting
Integumentary changes in the postpartum mother
- areola: get larger + darker
- linea nigra: pregnancy line, down stomach, fades (normally)
- striae gravidarum: stretch marks
- hair can thin out
- fingernails can become brittle
PUPPP
Pruritic urticarial papules and plaques of pregnancy: chronic hives-like rash, can commonly occur to women during pregnancy (no known long-term effects associated)
IMMEDIATE nursing assessemnt
*Vitals:
-Q15 minutes, 4 times total (first hour)
-Q30 minutes, 2 times total (second
hour)
-Q1 hour, 2 times total (3 & 4 hours)
*Uterine fundus
*Lochia
*Maternal statements
*Breastfeeding
*Pain
what findings during the immediate nursing assessment = hemorrhage?
**Elevated HR
**Decreased BP
**Increased RR
**Decreased urinary output
**Clammy skin
= HEMORRHAGE!!!!!!
notify HCP immediately!
E = episiotomy, perineum, laceration assessment & REEDA
R: redness E: edema E: ecchymosis (bruising) D: discharge &/+ drainage A: approximation
what injections/vaccinations are generally given during postpartum care
- rubella (cannot be given during pregnancy)
- flu (smaller dose + special types can be given during pregnancy)
- TDAP
- *only as/if needed, as ordered!
what is the number 1 cause of maternal death postpartum?
HEMORRHAGE!!!!!!!!!
early signs of postpartum hemorrhage
EARLY = WITHIN 24 HOURS OF BIRTH
**this is known as primary hemorrhage
caused by: uterine atony (when the uterus does not contract after delivery), lacerations, DIC
late signs of postpartum hemorrhage
LATE = 24 HOURS PP > 6 WEEKS PP
**this is known as secondary hemorrhage
caused by: infection, subinvolution, retained placental tissue, coagulopathy
what types of infections are common postpartum?
- endometritis: infection of the uterine lining, usually begins at location of placental attachment site
- lower UTI
- mastitis: infection of breast
